Health Policy Survey - California Health Care Foundation

Health Care Priorities and Experiences of California Residents:

Findings from the California Health Policy Survey

FEBRUARY 2020

AUTHORS Eran Ben-Porath, Emily Hachey, Jazmyne Sutton, and Jennifer Su, SSRS

Contents

Introduction .................................................................................................................................................. 3 Section 1. Priorities for California State Government .................................................................................. 4

Health Care Priorities ................................................................................................................................ 4 Section 2. Access and Experiences with Mental Health Care ....................................................................... 9

Policy Ideas to Increase Access to Mental Health Services ...................................................................... 9 Satisfaction with Mental Health Care ....................................................................................................... 9 Views and Stigma Around Mental Health and Addiction Treatment ....................................................... 9 Section 3. Perceptions on Homelessness....................................................................................................14 Section 4. Health Care Affordability............................................................................................................ 16 Section 5. Views on Medi-Cal......................................................................................................................21 Section 6. The Health Care Workforce........................................................................................................24 Section 7. Experiences of the Uninsured .................................................................................................... 26 Appendix A: Survey Methodology .............................................................................................................. 27 Appendix B: Demographic Tables ............................................................................................................... 30 B.1 Tables by Race and Income...............................................................................................................30 B.2 Tables by Region ............................................................................................................................... 36 B.3. Tables by Insurance Status 18?64.................................................................................................... 41 Endnotes ..................................................................................................................................................... 46

About the Authors

Eran Ben-Porath, PhD, is executive vice president; Emily Hachey, MS, is senior project director; Jazmyne Sutton, PhD, is senior project director; and Jennifer Su is research director at SSRS. SSRS is a full-service survey and market research firm that specializes in creative problem-solving and informed analysis to meet its partners' research goals.

About the Foundation

The California Health Care Foundation is dedicated to advancing meaningful, measurable improvements in the way the health care delivery system provides care to the people of California, particularly those with low incomes and those whose needs are not well served by the status quo. We work to ensure that people have access to the care they need, when they need it, at a price they can afford. CHCF informs policymakers and industry leaders, invests in ideas and innovations, and connects with changemakers to create a more responsive, patient-centered health care system. For more information, visit .

Health Care Priorities and Experiences of California Residents, January 2020

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Introduction

California is the most populous state in the country and home to an incredibly diverse population varying by income, age, and racial and ethnic backgrounds. This population is spread across the third largest state in land mass in the US, resulting in sometimes pronounced regional identities, experiences, and priorities. Despite these differences, Californians often come together to advance unifying social and public policies such as the expansion of health insurance coverage to nearly all of the state's residents, including undocumented children and young adults. The California Health Care Foundation and SSRS, a national survey research firm, conducted a representative statewide survey of California's residents in late 2019 about their views on health care policy in the state and their experiences with the health care system. Results from this survey are reported and compared to a previous survey published in 2019 to understand emerging trends.1 Key findings from this year's survey include:

? Making sure people with mental health problems can get the treatment they need is a top health care priority for the second year in a row.

? Just over half of Californians have skipped or postponed physical or mental health care due to cost. Of those who took such a cost-cutting step, 42% said it made their condition worse.

? Compared to last year's survey, Californians are more worried about affording unexpected medical bills, prescription drugs, out-of-pocket health care costs, and their health insurance premiums.

About the Survey

Note: The survey data used in this publication rely on self-reported insurance status. In addition, all mentions of employersponsored insurance coverage, Medi-Cal coverage, and uninsured status within this report are based only on nonelderly respondents (age 18 to 64), as data show this age group is significantly less likely to have health insurance coverage compared to adults 65 or older. This is mainly due to eligibility for the federal government's Medicare program at age 65. Due to this difference between age groups, nonelderly adults are the focus of analysis on insurance status within this report.

Source: Edward R. Berchick, Jessica C. Barnett, and Rachel D. Upton, Health Insurance Coverage in the United States: 2018, US Census Bureau, November 2019, content/dam/Census/library/publications/2019/demo/p60-267.pdf (PDF).

Figures may not sum due to rounding.

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Section 1. Priorities for California State Government

When asked to rate public policy priorities for the state's governor and legislature, health care remains a very high priority for Californians, with nearly half (45%) of residents rating making health care more affordable as "extremely important," and more than eight in 10 (84%) rating it either "extremely important" or "very important." Housing concerns topped Californians' priorities, with 49% saying addressing homelessness and making housing more affordable are each an "extremely important" priority (Figure 1).

Support for health care affordability as a priority varies by party identification. While it tops the list for Democrats, it ranks lower for Independents and Republicans. (Figure 2).

There are high levels of support for addressing the affordability of health care across racial, ethnic, and income categories, with support among higher-income and white Californians reaching nearly 80% (Figures 3 & 4).

The importance of addressing housing and homelessness also resonates strongly across racial, ethnic, and income groups in California. Addressing homelessness is identified as an "extremely important" or "very important" priority by 83% of the state's population overall, including more than 9 of 10 Black Californians (94%) and 8 of 10 white people (81%). Meanwhile, more than three-quarters (76%) of the state's residents identified housing affordability as a key priority, including 93% of Black people, 86% of Hispanics, and 70% of white people (Figure 3).

Health Care Priorities

For the second year in a row, California residents rate making sure people with mental health problems can get treatment as the top health care priority. Nine in 10 (90%) said this was "extremely important" or "very important" (52% "extremely"). Eighty-three percent of Californians identified making sure there are enough health care providers as an "extremely important" or "very important" priority (Figure 5).

Additionally, 82% view lowering the price of prescription drugs as an important priority (47% "extremely"). This is a statistically significant increase over last year's survey findings, when 75% said prescription drug costs were an important priority.

A large share (81%) view making sure all Californians have access to health insurance coverage as important (46% "extremely"). There is broad support for this issue across political parties with the majority of Democrats (93%; 62% "extremely"), Independents (83%; 44% "extremely"), and to a lesser extent, Republicans (53%; 19% "extremely") viewing this as an important issue.

A similar number (79%) view lowering the amount people pay for health care as important (43% "extremely"). There is also broad support for this priority across political parties, with most Democrats (91% important; 53% "extremely"), Independents (77%; 37% "extremely") and Republicans (64%; 32% "extremely") seeing this an important issue (Figure 6).

Fewer respondents (69%) report that access to treatment for people with alcohol and drug use problems is important (33% "extremely"). Finally, the only health priority that did not receive broad support was reducing state spending on health care with 42% support (14% "extremely").

Across income groups, those with lower incomes (below 200% of the federal poverty level) tended to view the number of health care providers as important (91%, 45% "extremely") compared to those with higher incomes (78%, 37% "extremely"). (Figure 7).

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Figure 1. Homelessness and Affordable Housing Rank High as Priorities for Californians

Q: HOW IMPORTANT DO YOU THINK IT IS FOR CALIFORNIA'S GOVERNOR AND LEGISLATURE TO WORK ON EACH OF THESE AREAS IN 2020?

Addressing homelessness Making housing more affordable

Improving public education Making health care more affordable Attracting and retaining businesses and jobs

Addressing climate change Improving infrastructure, like buildings and roads

Immigration enforcement

49% 49% 47% 45% 39% 39% 29% 28%

34%

14%

3%

27%

18%

6%

37%

14%

2%

39%

11%

5%

39%

17%

4%

25%

20%

15%

42%

26%

2%

29%

23%

18%

Extremely Important

Very Important

Somewhat Important

Not important / Should Not Be Done

Figure 2. Views of What California Lawmakers Should Work on Vary by Party

PERCENTAGE WHO SAY IT IS EXTREMELY IMPORTANT FOR THE CALIFORNIA GOVERNOR AND LEGISLATURE TO WORK ON EACH OF THESE AREAS IN 2020

Democrat

Independent

Republican

Making housing more affordable

Addressing homelessness

Improving public education

Making health care more affordable

Addressing climate change

Attracting and retaining businesses and jobs

Improving infrastructure like buildings and roads

Immigration enforcement

61% 56% 52%

62% 61% 36% 33% 17%

41% 46%

41% 38% 30% 38% 26% 22%

36% 40% 44%

21% 10%

54% 27%

56%

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Figure 3. Views on Priorities by Income

PERCENTAGE WHO VIEW EACH AS EXTREMELY OR VERY IMPORTANT

Making health care more affordable Making housing more affordable Addressing homelessness ................
................

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